Fitting curve parameters.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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As the demand to fabricate larger and increasingly complex aspheric optics becomes more common, the need for deterministic polishing tools which can meet these demands has motivated the development of the hydrodynamic, polishing tool (HyDRa).
The HyDRa polishing tool [1, 2] is a non-contact, zero-force hydrodynamic tool that rotationally accelerates a slurry and air mixture and expels it tangentially onto the workpiece. It consists of several operational stages: an abrasive suspension (water and polishing grit) is fed to the tool’s first operational stage, where it is mixed with air at a controlled pressure in order to produce a variable-density abrasive foam. This foam then enters the rotational acceleration chamber, where it is sped up to high revolutions per minute (RPM). The rotational energy of the flow then turns into radial velocity in a nozzle that forms between the tool’s divergent output and the workpiece. In this way, the abrasive particles graze the workpiece in closely tangential trajectories. Thus, the polishing particles generate a shearing action that removes material in a ductile removal process, as described in [3]. The drag generated by this radial flow forms a central low-pressure zone (vacuum) surrounded by a high-pressure ring. As a result, the tool floats over the workpiece, exerting no net force onto it [4], since these regions cancel each other out. This poses many advantages in modern deterministic polishing, in particular the capability of polishing ultra-thin surfaces, such as semiconductor wafers and optical membranes.
The HyDRa tool belongs to the fluid jet polishing (FJP) family, originally developed by Fähnle et al. [5]. Although HyDRa also expels an abrasive suspension onto the surface to be polished, there are several basic operational principles that differ from the classic FJP technique. The FJP method, and most other polishing techniques, needs to apply pressure onto the workpiece, in order to remove material. In some cases, as in the classic FJP technique, the force that is exerted onto the material can be minimized by using a small contact area; see for example [6], where the force on the workpiece is less than 1 N. This however, could represent a trade-off between footprint size and removal rate; removal rates of <0.01 mm3/h are common for 1–2 μm Cerium oxide polisher [6]. Other deterministic methods, such as ion beam figuring (IBF), are non-contact, zero-force processes that present removal rates of up to 50 mm3/min [7] without degrading the initial micro-roughness.
This section describes the generalities of polishing with the HyDRa system. A typical static removal footprint is shown in Figure 1.
Tool influence function. The image to the right shows the removal function profile extracted from the interferogram to the left. This profile was obtained by operating the tool for 2 s on a fixed position over the workpiece. DH is the full width at half maximum (FWHM) of the removal function. Tool footprint diameters typically range between 3 and 10 mm, depending on the particular tool.
As can be seen, the removal takes place in a ~5 mm diameter region that has an M-shaped geometry. Removal in the central region is about 20% lower than the peripheral region. Removal is a function of slurry density (ρ) and accelerating air pressure (PT), slurry flow, i.e., flow rate (F1), and is a linear function of dwell-time. In order to attain deterministic polishing, all tool parameters are controlled with high precision, as described in Section 4.
The HyDRa tool is part of a complex polishing robot, consisting of a CNC positioning device; a fluid and compressed air control system; a slurry management unit, which stirs the slurry and controls its density; and a software package that obtains error maps from a series of interferometers, and generates dwell-time/constant-velocity PWM trajectories. These trajectories correct the workpiece figure, depending on the selected method (pulsed or continuous operation), as the block-diagram of Figure 2 illustrates.
HyDRa polishing process setup, (see text).
The HyDRa tool is attached to a five degree of freedom (DOF) polishing machine with force feedback, based on a 2.4 × 2.4 m Cartesian CNC, with two additional DOF (tip and tilt), implemented by means of a 3-actuator hexapod. This configuration allows the generation and polishing of any surface geometry. Since feedback control keeps all polishing parameters constant, removal is exclusively a function of dwell-time. In this way, figure correction depends on the trajectory followed by the tool and the velocity at each point along it, which requires that the CNC be capable of following five-dimensional, controlled-velocity trajectories. Simultaneously, z-axis movement is controlled so that the tool can accurately follow the surface contour with zero-force. Although the machine’s repeatability is around 10 μm, the removal is accomplished with nanometric accuracy due to a load cell that regulates tool height over the workpiece, as reported in [4]. The slurry conditioning unit (SCU) supplies a density controlled polishing suspension to the HyDRa slurry supply system. It also captures and reincorporates the liquid and atomized slurry that is expelled from the tool. The density is continuously monitored by means of a photodensitometer and controlled by means of polishing-paste and water supply systems. The expelled slurry is captured by the return system, which consists of a blower that reincorporates this slurry and air into the SCU container, forcing the mixture through a washed-air system.
A pump is continually recirculating the polisher in the container, and a derivation supplies filtered slurry to the HyDRa slurry control system. The slurry that flows into the tool is fed by means of a damped-diaphragm DC pump that is feedback-controlled by means of either a flow meter or a pressure sensor. In order to reduce air contamination, the HyDRa system polishes in shallow immersion so that an air-lock for the return system is formed. The HyDRa tool accelerates an abrasive foam, composed of a variable-density suspension of slurry and air created by means of an air control system that regulates the foaming and propelling air pressures using electromechanic air regulators, pressure sensors and control electronics. All polishing parameters are acquired with a data acquisition card, and controlled and visualized in LabView®. The surface is fixed onto the CNC platform as the tool is swept over the surface in a pattern chosen by the user. Pulsed operation of the tool sweeps the tool(s) along the workpiece at a constant velocity, switching the polishing action on and off depending on how much material needs to be removed. The slurry is fed to the tool at controlled pressures and flow rates. The tool is supplied with compressed air to operate the foaming and acceleration stages. The abrasive foam is radially expelled through the tool nozzle onto the surface to be polished, as described above. Tool height is controlled by the feedback variable provided by the load cell, so that the CNC can adjust tool height in order to polish with zero force, as is discussed below.
One of the central advantages of the HyDRa tool resides in that it can be adjusted to exert zero force on the work surface, while maintaining considerable removal rates (~10 mm3/h). The flotation effect is described in more depth in this section.
As the HyDRa tool expels the slurry through its nozzle, the rotational energy of the flow is converted to radial velocity. The drag generated by this radial flow produces a central low-pressure zone that is surrounded by a vortex which is in turn confined by a ring shaped, positive thrust zone. This effect differs from the linear jet polishing technique [3, 8] in that, in normal-incidence, classic jets, the pressure profile is represented by a Gaussian distribution, where the maximum is located at the jet’s center. In contrast, the pressure distribution of HyDRa on the workpiece presents negative values at the footprint’s center and is circumscribed by an annular, positive-pressure region. With this, the force on the workpiece can be adjusted to net zero-force. In Figure 3a, footprint pressure vs. distance from the center of the tool is plotted. This was obtained by means of a 0.46 mm diameter orifice connected to a pressure sensor over which the tool footprint was radially scanned. As can be seen, a low pressure zone forms at the central part of the footprint and, as the radius increases, the gauge pressure increases to a maximum. It then falls again as the orifice approaches the tool’s outer radius.
(a) (left) Pressure distribution as a function of tool radius for different operating pressures. (b) (right) Force applied by the HyDRa tool as a function of distance Z from the work surface for accelerating pressures PT = 20, 30, 40 and 50 PSI. For clarity, a constant offset has been added to the 30, 40 and 50 cases. Typical error bars are 0.1 N for the load cell and 20 μm for the Z position. The solid lines are an analytical function fit derived from a Morse potential. In the upper right inset, the restitution spring constant is shown to be related to PT. When an external holding force Fh is applied to the tool and pushes it against the workpiece, the vacuum force Fv has a tendency to decrease as the thrust force Fe is increased.
As the tool moves away from the workpiece, the vacuum has a tendency to increase, as the thrust force tends to decrease; in consequence, the balance of these two forces is a function of the tool’s distance from the surface to be polished. With this, several operational modes can be achieved, one of them allowing the tool to freely float over the surface without the need to rigidly attach it to a positioning device. In this case, the tool’s weight is counterbalanced by the thrust and vacuum forces. When the HyDRa tool is mounted onto a passive hexapod through a load cell, the support force Fh counterbalances the tool weight mg and the remaining forces to zero, while maintaining the tool in a static position.
The load cell value Fh is then used as feedback for the control system to maintain zero force on the workpiece. This is done by adjusting the z-axis of the CNC/hexapod.
We measured the tool and workpiece force interactions as a function of separation. In Figure 3b, the overall behavior of this interaction is shown in experiments where slurry accelerating pressures of 20 to 50 PSI and a polishing slurry flow of 5 ml/s were used. The distance over the workpiece was modified from several millimeters, down to a few hundred microns. The values of the load cell Fh were used to obtain the substrate force Fx, as explained above.
When the tool exceeds a certain distance, the workpiece experiences no force (see Figure 3). As the tool approaches the substrate, a negative force (attraction) is produced by a vacuum that develops between the workpiece and the HyDRa tool. As the tool further approaches the workpiece, a positive repulsion force is experienced, caused by the thrust force. At a few hundred μm from the workpiece, the vacuum and thrust forces balance each other out to zero. Here the surface can be polished without being deformed by the tool.
The combination of attractive and repulsive forces commonly arises in physical problems. One of such is given by the empirical Morse potential of diatomic molecules
50 | 10 | 1.36 | 0.36 | 40 |
40 | 7.5 | 1.36 | 0.34 | 27.7 |
30 | 5.1 | 1.36 | 0.34 | 18.9 |
20 | 3 | 1.36 | 0.34 | 11.1 |
Fitting curve parameters.
Several tools have been developed to accommodate for different removal rates that range from 1 to 600 mm3/h. This section presents measurements of static and volumetric removal rates for a medium removal-rate tool with a nozzle diameter of 3.8 mm. Several polisher grits have been tested: Cerium oxide (Opaline) with a particle size of 1 μm, and aluminum oxide (μ-grit) with particle sizes of 5 and 12 μm, suspended in water at a constant relative density of 1.09. Samples of different materials were polished: standard window glass, water-free fused silica (Infrasil®-302), BK-7 borosilicate, and Ohara’s CLEARCERAM-Z® vitroceramic.
The measurements were performed by scan-sliding the tool over the sample at a constant speed and a corresponding zero-force tool height. The resulting cavity was measured interferometrically, and both the volume of removed material and the depth of the cavity were calculated. With these measurements the static removal rate DS (depth/time) and the volumetric removal rate DV were then calculated. We performed these measurements at different operational conditions of accelerating pressure (PT) and slurry flow (fp). In all cases, the relative density of the slurry was kept at 1.09. In Figure 4, the test results are shown. In all three panels, the left vertical axis DV is related to DS as DV = DS* A, where A is the tool footprint area. Each plot indicates the dependence of removal on the accelerating pressure PT. The top left panel, where Cerium oxide was used, slurry flow fp values of 3, 5 and 7 ml/s on window glass were tested. These are indicated as numbers on the curve.
Volumetric removal rate DV as a function of accelerating pressure (PT) for various polisher types: 1 μm cerium oxide (Opaline), 5 μm aluminum oxide (μgrit) and 12 μm aluminum oxide. Opaline removal rates are presented for window glass (solid line), fused silica, and borosilicate (dotted line). Removal of μ-grit is shown for window glass and CLEARCERAM®-Z vitroceramic. All fitted curves are versions of the same second order polynomial law, scaled by a factor that is a function of substrate material and particle size (see text). Zero-force polishing was achieved at the corresponding tool height for this effect.
As can be noted, the highest removal rate for this tool is achieved with a slurry flow of 5 ml/s, thus this flow was employed for all consecutive experiments. Removal rates up to 2.5 mm3/h at 50 PSI are obtained for this polisher. The fp = 5 points are well fitted by a second order polynomial. In the first panel we also show the results of polishing a fused silica sample (crosses). In this case the hardness of the material causes the removal rate to decrease to 66% compared to window glass. The dotted line that fits these values is obtained by multiplying the same DS polynomial by a small factor. In the lower left panel we tested the removal rate of 5 μm aluminum oxide grit on glass (crosses). The volumetric removal rate rises to ~50 mm3/h at an accelerating pressure of 50 PSI. The solid line is the DS polynomial obtained previously, multiplied by 19. Again, a very good fit can be seen. Lastly, in the lower-right panel, the removal rate of aluminum oxide grit (12 μm particle size) on Ohara CLEARCERAM® vitroceramic is shown. Removal was so large that it was impossible to measure it reliably with an interferometer, so the resulting cavity was measured by means of a needle profilometer. Only two points were taken in this experiment (crosses in the last graph). If the same polynomial DS were to be fitted (dashed line), it would have to be multiplied by 94. For all cases, the removed volume per abrasive particle is 3 to 5 orders of magnitude lower than the particle’s volume. The kinetic energy as well as the grazing incidence associated with both the cerium and alumina particles, creates stresses that are not large enough to produce permanent dents. Resulting typical micro-roughnesses of 2, 24, and 31 nm, for grit sizes of 1, 5, and 12 μm, respectively, are around three orders of magnitude smaller than the particle sizes. These tests demonstrate that independently of grit size and material, as well as substrate hardness, behavior of removal as a function of accelerating tool pressure is comparable, which indicates that the same material removal process discussed above is taking place. The scaling parameter is an indicator of how efficiently a particular abrasive removes material from a surface of a given hardness. All HyDRa tools present this same relationship of removal as a function of PT and grit size for pressures of up to 90 PSI. Currently, typical removal rates of ~15 mm3/h @ 90 PSI, using 1 μm Opaline on borosilicate glass, are common.
The HyDRa trajectory planning tool (HyTPT) is a software package developed specifically for the HyDRa tool [9]. It feeds machining code to a CNC or any computer-controlled positioning device, based on the error map that has been obtained interferometrically. When only one HyDRa tool is available, the amount of material that is removed at each specific position is proportional to the dwell time. This dwell time can be controlled either by the speed of the tool along a given trajectory when the tool is operated in continuous mode, or by the width of the pulses when operated in pulsed mode.
In HyTPT (Figure 5) a main window presents the project name and grants the user the ability to go from error maps to machine coordinates in four steps:
Error Map alignment: This allows the easy alignment of the error map, and the determination of its center, orientation and pixel size. The basic shapes are rectangular, circular, and annular surfaces.
Base trajector: It is possible to select the base trajectory from a series of curves: from simple raster patterns to more complex curves, such as trochoids and rotating triangles. It is possible to define and analyze each curve from the point of view of trajectory density, total polishing time, and speed at each point, among several others.
Surface shape: The shape of the surface, currently any on- or off-axis conic section, is defined in this window. The 2-D base trajectory is projected onto this 3-D surface. In addition to the 3-D trajectory the normal vector to the surface at each position is calculated, so that the CNC may orient the HyDRa tool normal to the surface along the trajectory.
Machine coordinates: A set of alignment tools facilitates the transformation of surface coordinates to machine coordinates. These routines communicate with the CNC machine and are developed for each particular CNC or robot arm to which the HyDRa tool is attached. Finally, the centering and orientation parameters, nine in total, are determined in order to properly align the system. Once each of these parameters has been calculated, the trajectory is delivered to the CNC machine, or robot arm so it can be executed there.
HyTPT software main interface showing all four steps.
Due to its hydrodynamic properties, the original HyDRa tool [1] does not allow the modification or switching of any of its operational parameters during operation. Therefore, in order to control the removal, dwell time is modified by means of tool velocity. However, there is a maximum tool velocity imposed by CNC limitations, that fixes a minimum, non-zero amount of material that can be removed with the tool. This poses problems for several operational applications, such as zonal corrections, multi-head or tessellated polishing, and edge problems. A new HyDRa tool design (patent pending) [2] overcomes these problems, by switching one of the operational parameters (polisher flow). This enables the pulsing of the abrasive action at will, without affecting tool bias. The ability to operate the HyDRa tool in a switched manner widens its overall performance and efficiency, adding new applications. It is not simple to switch most of the tool’s operational parameters during use, since this causes a loss of tool bias, which affects the flotation capability. Restoring these parameters on the fly takes time and produces unwanted effects such as cavitation. This has limited the polishing strategy to making full sweeps of the entire surface. When needing to polish only a small section, the region must be approached with the tool biased, leaving behind an unwanted track and approach and exit marks. A new HyDRa tool design has been developed which allows switching slurry flow without losing tool bias. Switching frequencies of up to 10 Hz, and pulses as narrow as 10 ms, can be achieved with this new tool. This is accomplished by means of an overdriven electro-valve which is installed in, or close to, the tool. This allows the use of polishing pulses that can be applied on a per-pixel basis or in a continuous scan using pulse width modulation (PWM) techniques. With this feature, dwell time can be controlled below the minimum attainable by a continuous action at the maximum CNC speed.
A pulsed HyDRa tool with a 7 mm footprint has been developed and tested for linearity. Figure 6a shows the results of erosion vs. dwell-time. Pulse width was varied at constant increments, starting from 10 ms to a maximum of 500 ms, as the tool was moved at 0.2 mm increments, overlapping 35 times at each tool footprint diameter. The erosion was measured using a Fizeau interferometer and the result was normalized, so that removal corresponded to a single pass of the tool over each point along the line that was polished. Error bars are primarily due to errors produced by the subtraction of the base reference during interferogram reduction. A removal resolution of 0.1 nm/ms can be seen from the data. Noticeable polishing effects were observed at 25 ms. We attribute this effect to the electro-valve response time, which can be improved by using faster actuators.
(a) Erosion vs. pulse-width in a linearity test. (b) Response function of the tool for pulsed operation at constant tool velocity. The tool was switched in a PWM mode, with a 50% duty cycle and 100 ms on/off switching times. The raster pattern used to generate this surface is perpendicular to the surface produced in the figure. Pixel size is limited by footprint size. Tool velocity was chosen so the pulses could be resolved independently.
It is now possible to control the duration of a pulse as a fraction of the time it takes the tool to travel a distance of one footprint diameter.
The depth of removed material for a raster scan pattern h, can be given by:
where DV is the volumetric removal rate, Y is the PWM duty cycle (ON time divided by the period T), V is the CNC velocity, and S is the raster step size. The period of the switching signal is T = D/V, where D is the tool footprint diameter. In the time it takes to cross a tool footprint, there is a single pulse whose width can be varied from zero to the entire footprint diameter. The depth of the removed material h = βτ is proportional to the dwell time τ, defined by τ = YD/V, with a proportionality constant β = DV/SD. When Y = 1, which is the continuous mode, tool removal (dwell time) h is controlled by CNC velocity. When Y < 1, which is the pulsed mode, h is controlled by means of switching the slurry supply and keeping the tool velocity constant. The continuous mode is limited to removals greater than h{min} = DV Y/V{max}S. In order to obtain a lower removal, the pulsed mode must be employed.
For a tool footprint diameter of 7 mm and a maximum CNC velocity of 2000 mm/min, the minimum period of the switching signal will be 0.2 seg, or 5 HZ, which is within the 10 Hz switching frequency range. In an extreme case, where the duty cycle is switched between 0 and 1 while maintaining a constant velocity, it is possible to create a pixelated pattern that is useful for determining the response function of the pulsed tool (Figure 6b). A fringed pattern can be observed where the interface between the regions presents a slope that corresponds to the tool footprint diameter, which is the limiting polishing element size (poxel, or polishing element).
When only a small section of the surface needs to be polished, this region must be approached with the tool turned on, leaving behind unwanted tracks, as well as approach and exit marks. This is solved by using the pulsed mode of the HyDRa tool. When an isolated region that needs further polishing is identified, a dampening band of constant width surrounding it is defined. Assuming a raster pattern is used, the region is approached with the HyDRa tool fully operational with Y = 0, until it enters the dampening region. Here velocity is smoothly incremented to the value needed inside the region while at the same time, the desired dwell time is controlled by means of PWM. The width of the dampening region is determined by the CNC acceleration and deceleration capabilities. Inside the region to be corrected, either a pulsed or continuous polishing can be used in order to maximize efficiency.
In the constant velocity PWM polishing case, the resulting response function in the sweep direction is different from the response function of the transverse, raster direction. When a symmetrical finishing is needed, it is possible to employ the pixel polishing method, which consists of stepping the tool at discrete positions with respect to each other, covering the region of interest with the same step increments in both axes. The tool is then switched on for the necessary time in order to achieve the desired removal for each position. This method can also be useful when very localized zonal polishing is needed. This allows the tool to either follow a raster pattern, or any other trajectory or set of discrete positions over the region of interest. An example of this method was used in Section 3.1 for the linearity test, where it was shown that a removal resolution of 0.1 nm can be attained.
In the polishing of meter-class surfaces, efficiency is limited due to HyDRa’s small footprint size and volumetric removal rate. Efficiency, however, can be improved by simultaneously polishing the surface with several HyDRa tools. These tools can be mounted on independent polishing robots, where each robot tackles a certain section of the surface. Alternatively, several tools can be mounted on a single robot arm, as described below. This method poses several problems, such as obtaining smooth seams between sections, approaching each section without leaving marks, and avoiding collisions as two tools concurrently approach the boundary between sections. In order to obtain a seamless interface between two independent sections, it is necessary to approach the boundary following special trajectories, such as the wedge pattern shown in Figure 7 (bottom). This trajectory avoids duplicating dwell time at the seam, such as would happen if a rectangular pattern were used (top of Figure 7).
Tessellated polishing showing two different trajectory approaches. The figures to the left show the region of the interface between two raster patterns that use a rectangular (upper) and wedge (lower) seam at the boundary. The middle figures show a simulation of the resulting removal with the tool moving at a constant velocity and without PWM. Note the approach/exit tool mark at the beginning/end of the trajectory due to not switching the tool off. The interferograms to the right are actual polishing experiments. As can be seen, the raster pattern using rectangular trajectories duplicates removal at the seam, whereas the wedge trajectory produces a seamless interface. Another possible solution is to vary the pulse width at the seam, in order to match the dwell time between adjacent polishing sections.
When the polishing process needs to be interrupted, it is now possible to stop at any point on the surface and continue polishing at a later time.
As in other polishing methods, the HyDRa tool tends to leave a small (one footprint diameter) fallen edge. In order to overcome this with the unmodified HyDRa tool, tool velocity is incremented as the tool approaches the edge, reducing dwell-time. This is counterintuitive and can present CNC control problems, since the tool is accelerated in a region where it should be preparing for a raster direction change. The on–off capability of the new tool can alleviate this problem, since dwell-time can be controlled without having to increment tool velocity at the edge region. In fact, this method allows for decelerating the CNC in order to prepare for a direction change.
Another advantage of being able to pulse the tool is a quicker convergence towards the desired surface [10]. As pointed out in [11], the existence of a minimum amount that will be removed due to not being able to turn the tool off (hmin), limits the amount of material that can be removed in each run, whereas, by being able to pulse the tool, hmin can be made zero, allowing for a maximum value of f, further increasing the polishing convergence rate.
Since HyDRa tools can now be pulsed, several polishing heads can be mounted onto a common arm which moves at a constant velocity over the surface. Dwell time is then controlled using PWM for each tool, as required by the error map. We can also take advantage of the self-conforming capabilities of HyDRa, in that it is not necessary to employ a positioning device to conform the parallelism of the tool to the surface. Only one degree of freedom (DOF) per tool is required. Each loop is closed with a load cell signal and implemented by means of a linear stage, which permits zero-force polishing while freely following the local sag and tilt of the surface. Another advantage of this type of polishing is that one single slurry supply system can be used for all the tools, simplifying the system and considerably reducing the costs. Polishing efficiency becomes a function of the number of tools, and in the case of a matrix configuration, several polishing runs can be implemented into a single sweep, reducing polishing time.
By polishing with several tools, each tool is essentially given a section of the surface and the boundaries between sections are finished seamlessly, either by employing wedged joints, or by using PWM. Among the possible multi-tool configurations are matrix, linear and spiral layouts:
By mounting several HyDRa tools onto a single polishing arm, attached to a Cartesian CNC machine, it is possible to cover an area by sweeping the arm in the x and y directions. Each tool is separated from the next by a fixed distance δ in the x axis. The sweeping action in the x axis is done by moving the arm by δ, and then advancing with the selected raster step in the y axis. The overlap between the sections assigned to each tool is managed by either using tessellated or the PWM techniques, as described above. There are certain considerations to be taken into account for this method, particularly due to the edge problem that arises when polishing circular or non-rectangular surfaces. There will always be a tool that needs to either enter or exit the surface, while others are already polishing. Additionally, since these tools need to take advantage of their self-conforming capability, as they approach the edge of the workpiece, they loose floatability. These problems can be dealt with by adequate trajectory programming.
The linear configuration can be expanded by creating a matrix of tightly packed HyDRa tools maximizing tool number in order to minimize polishing time. The working principle is the same as the linear case, but adding M rows. This is equivalent to carrying out M polishing runs in a single iteration.
In the case of large circular mirrors, it may be more efficient to polish the mirror by placing it on a rotary table. If we seek to fix as many HyDRa tools as possible onto a single arm, two conditions must be met. First, the number of tools should increase as r2, so that each tool covers the same mirror area. Secondly, tools must be packed at the maximum allowable density, so that each tool sits next to the following one. Therefore, the shape of the arm must be a kind of spiral which is possible to solve for. By calculus of variations a spiral curve parameterized by the (increasing) radial coordinate, given in polar coordinates (r, θ) results in:
Hydra tools mounted on a spiral arm (see text).
Of the multiple finishing techniques currently in use, the ones based on sub-aperture polishing may be candidates for deterministic polishing, provided that the uncertainty of key polishing parameters is minimized. Deterministic polishing relies on a stable and predictable tool influence function; thus it is imperative that it is fully characterized for each material that will be polished. Simultaneously, metrology is a determining factor of the final quality of the surface, since it limits the precision of the error maps that can be obtained. This requires the knowledge of a series of polishing parameters such as tool velocity, pressure and height as well as slurry type, temperature, etc. Most of these parameters remain constant during the time periods required for polishing small optics, i.e. a few minutes. If larger, meter-class surfaces need to be polished, it is important to control and keep all parameters constant during an entire polishing run, which can represent over 10 h. Thus, a very stable and precise process control of the process is required.
The HyDRa tool removal function is based mainly on four independent operating parameters: propelling air pressure, grit mass concentration, height of the tool over the surface to be polished, and slurry flow and/or slurry pressure. In order to ensure deterministically polished surfaces, the errors contributed by each of these factors must be taken into account and precisely controlled to 1% for the entire length of the polishing run (over 100 h). Simultaneously, metrology is crucial for determining the surface’s final quality, since it dictates the limit of the precision of the error maps that can be obtained.
To maximize polishing performance, an abrasive foam is created in the tool’s first stage. This raises the velocity of the polishing particles, improving the removal of material. This foam is produced by combining a constant flow f (a few ml/s) slurry, with air that is kept at a constant pressure Pp. This fluid is then accelerated with pressurized air at a propelling pressure PT, in one or more cylindrical cavities. The resulting abrasive foam is then expelled through the tool’s nozzle, where a vortex is produced that develops into a radial flow, and generates a grazing, uniform removal footprint. A relation of slurry flow f to slurry pressure Pp exists for each value of accelerating pressure PT. This, in addition, depends on the tool’s physical characteristics, such as its overall dimensions, the geometry of the acceleration chamber(s), as well as the nozzle shape. This relation establishes an operational diagram that defines tool bias. In this section, the control of f is chosen, although it is possible to select to control for either f or Pp. The removal D of HyDRa mainly depends on four independent operating parameters: propelling air pressure PT, grit mass concentration ρi, slurry flow f, and distance of the tool over the workpiece Z. In order for deterministically polished surfaces to be obtained, the errors contributed by each of these parameters must be taken into account and controlled.
The removal rates, as determined by a series of independent experiments, where the polishing parameters varied, are shown in Figure 9.
Normalized removal rate D/D¯ (dimensionless) with reference to the normalized value of certain polishing parameters (mass concentration ρi, propelling pressure PT, slurry flow f and tool height z). The sensitivity of removal to each parameter is indicated in the upper left corner of each graph.
To generalize the analysis, all parameters X are normalized around their operational values as
In the case of tool height z, load cell force Fc can be used instead, since, as shown in [4] tool force is an approximate linear function of distance when close to the operation point, given that z + K Fc, with K~10 𝜇m/N, and hence δz = δFc..
If we assume that each of these four variables is statistically independent, the total error can be added in quadrature. For example, if each parameter is controlled to ~1% precision, then the total error δDT is
As mentioned before, in order to deterministically polish large surfaces it is imperative that removal rate remains stable over extended time periods. We polished an 84-cm hyperbolic primary mirror to λ/10 RMS, 0.7 λ PV in order to prove that HyDRa could deterministically tackle meter-class optics. The polishing process is described in [12]. From the error maps that were acquired during the iterations, the level of determinism of the process could be calculated. From each map we computed a tool trajectory with distinct dwell times. The amount of removed material was calculated by subtracting the previous error map from the measured one. Then, from the obtained result after polishing, the removed material for each iteration was determined and plotted as a function of dwell time. Refer to Figure 10. A linear relation is expected and the deviation from this represents the level of determinism, Figure 11. This experiment was useful to evaluate the importance of the stability of each parameter in the level of determinism for prolonged time periods. In the figure, a larger error can be noticed for shorter dwell-times than for longer ones. This is due to CNC errors when the tool has to be quickly accelerated to obtain short dwell-times. As the mirror is progressively corrected, the surface is smoother and these changes tend to decrease.
An 84 cm mirror with a 1 cm thick faceplate that was polished using the HyDRa system. (a) Picture of the mirror’s internal back-structure. (b) Mirror prior to HyDRa finishing. The print-through left by the original lap-polishing process can be noted. (c) Mirror surface after HyDRa polishing. The polishing process entirely removed the print-through by polishing with the zero-force, error-map based process described in this chapter. Low-order Zernikes have been removed so this effect is highlighted. Z-scales are the same and are shown as vertical bars in nm.
Total amount of material removed in the final iteration (3 runs = 30 h), as a function of dwell time in each area element of 2.6 × 2.6 mm2 (pixel size). A linear relation at a removal rate of 13 mm3/h (shown as a solid line) is expected for an entirely deterministic process. The true deviations from this behavior amount to 10.6%, which is the attained level of non-determinism and represents the standard deviation of the points with respect to the best-fit line.
Three components in the power spectral density (PSD) of the residual surface errors that are related to the footprint diameter of the tool DH exist for any given polishing method. In the low frequency domain (L >> DH), the surface errors (optical figure) are a function of the stability of the polishing parameters during the polishing run, while at the high-frequency domain (L << DH), the physics of the polishing process determine surface quality (micro-roughness). In the case of mid-spatial frequencies (L~DH) surface quality depends on the geometry and overlap of the polishing trajectories. We obtained PSD measurements as described in [4] and references therein. The PSD is discussed using the results obtained while polishing four 50 mm etalon plates to better than λ/100. These 50 mm diameter water-free fused silica plates are used in an NIR scanning Fabry-Perot interferometer. These surfaces were polished using the HyDRa tool discussed in Section 4. Surface measurements were taken with a phase-shifting (PS) Fizeau interferometer in order to quantify the figure with a 180 μm pixel size projected onto the surface. A PS Linnik interferometer with 2× and 50× objectives (equivalent pixel sizes of 7.6 and 0.16 μm) was used to determine mid- and high-spatial frequencies, respectively. In Figure 11a, the 2-dimensional power spectrum PSD2 vs. spatial frequency is plotted. It can be noted that three overlapping regimes exist that correspond to the series of instruments that were used to evaluate the surface quality. The integrated RMS values for each regime are 3.8, 1.5 and 2.9 nm for low-, mid- and high-spatial frequencies, respectively. The overall slope is approximately described as
(a) 2-D power spectral density PSD2 as a function of linear spatial frequency obtained with HyDRa on an etalon plate. (b) One of four etalon plates prior and after HyDRa polishing. The wrapped phase of the surface before (left) and after (right) polishing is shown in the upper images. Unwrapped phases of the original and polished surface, respectively (lower images). The inscribed green circle delimits the plate’s usable region. Of the 50 mm plate diameter, only the central 40 mm were polished, since the exterior ring is used for mounting the plates. This area is indicated within the light-colored circle.
Interferograms [10] showed initial figure errors that ranged between 27 and 83 nm. Using these measurements, we calculated the error maps to compute a dwell-time based raster pattern trajectory for the CNC polishing machine. An acceleration pressure of 40 PSI was chosen and tool height was controlled to achieve zero-force on the workpiece. RMS surface qualities between 3.6 and 6.8 nm were obtained after two 15 min polishing runs. The low frequency interval of the PSD shows an overall RMS fit to the desired figure of 3.8 nm, which is in accordance with the results presented in the previous section: a final surface figure quality of >>λ/100 for visible wavelengths. Sub-aperture polishing can introduce unwanted patterns associated with the polishing trajectories [14] which can occur in HyDRa polishing with a 7 mm footprint on a 40 mm sample. To minimize these mid-spatial frequencies, the tool was raster-scanned with 0.25 mm steps, which corresponds to 1/20th of the tool’s footprint size. Traces of this raster pattern should have been visible in the 0.14–4 mm−1 frequency range on the PSD. However, no evident peaks that could have been related to grooves left by a raster pattern could be observed, and only a tiny peak corresponding to about 100 μm could be noted. This peak adds a very small fraction of a nm to the total 1.5 nm RMS of the mid-frequency band, demonstrating that “over-rastering” can be effective in minimizing mid-spatial frequencies. This represents an alternative to the approach proposed by Fähnle [15], using only one tool. A comparatively large footprint has the extra advantage of making our process insensitive to CNC positioning errors, which are two orders of magnitude smaller than the footprint size. Finally, the high-spatial frequency domain shows an RMS of close to 3 nm. Although the PSD decreases in this region, it apparently stabilizes at frequencies >103 mm−1 or sizes smaller than 1 μm. This number is related to the grit size that was used in this test. To sustain a decreasing PSD tendency and thus, smaller values of the high-frequency RMS, the use of smaller grit sizes is suggested. Integrating the high-frequency domain of the PSD to obtain the RMS is also equivalent to calculating the RMS directly from a 50 × 50 μm area of the micro-interferogram, according to a standard definition of micro-roughness [16]. This micro-roughness obtained with the HyDRa process (3 nm) is comparable to the roughness reported in current FJP literature [5].
This work was funded by Universidad Nacional Autónoma de México DGAPA-PAPIIT grants IN112505, IN115509, IT100216 and IT100118, as well as by Instituto de Astronomía, UNAM.
Poisoning is the second leading cause of injury-related morbidity and mortality in the United States, with more than 2.4 million toxic exposures reported each year [1].
Antidotes, remedies or agents counteracting or neutralizing the action of poisons (MeSH and Emtree definitions, from Dorland’s Medical Dictionary, 32nd edition), apply their useful impacts through an assortment of components, including the development of an inactive complex with the venom, the speeding up of venom detoxification, the decrease of venom transformation rate to a progressively dangerous compound, rivalry with venom for fundamental receptor locales, blockage of basic receptors through which lethal impacts are intervened, and avoidance of venom impact. There are explicit antidotes for few toxins, and a couple of counteractants are routinely utilized in clinical practice. These are acetylcysteine, naloxone and flumazenil.
Antidotal therapy is a critical aspect of the poisoning management in emergency setting: prompt availability and sufficient amount are essential, particularly when these molecules represent life-saving therapy for the acute poisoned patient.
Pharmacists can help reduce morbidity and mortality due to poisonings and overdoses by recognizing the signs exposure, guiding emergency room staff on the appropriate use of antidotes and supportive therapies, helping to ensure appropriate monitoring of patients for antidote response and adverse effects and managing the procurement and stocking of antidotes to ensure their timely availability [2].
Antidotes are essential medicines for the management of some of the emergencies attended in the hospital environment, and the speed of administration can be a key element for the survival of the patient. The Hospital Pharmacy Services are responsible for guaranteeing its availability [3, 4, 5, 6].
However, it can be affected by several causes:
Frequency of presentation of an intoxication in a geographical area
Urgency in administration
Difficulties of acquisition
Cost
Period of validity
Therefore, it is necessary to create a tool that facilitates the exchange of antidotes between hospitals and ensures their availability.
For example, in other countries like in the USA, to appropriately prepare for bioterrorism response, the governmental Agency that optimally provides the surveillance and planning guidance is the Centers for Disease Control and Prevention (CDC). Pharmacists can play a key role in reducing poisoning and overdose injuries and deaths by assisting in the early recognition of toxic exposures and guiding emergency personnel on the proper storage, selection, and use of antidotal therapies. The clinical pharmacist for a hospital is creating a protocol for the pharmacy department in the event of a biological disaster. Five elements that are critical to the protocol follow the National Preparedness Goal (NPG) created to prepare the United States for threats that pose risks to the nation, including acts of terrorism. The five mission areas that were identified in order to achieve the NPG are: Prevention, protection, mitigation, response, and recovery. The pharmacy department of a given hospital stores a Strategic National Stockpile (SNS) cache for use in a disaster. The person that authorizes deployment of the stockpile is the State governor’s office, and thereafter, Pharmacy director and Hospital Incident Command System (HICS).
Inadequate stock or insufficient number of antidotes is a common and diffused problem in the Emergency Departments in many countries. In Italy, based on this consideration, from 2003 to 2012 two National surveys has been conducted from Pavia Poison Control Centre (Pavia-PCC) with the grant of the Italian Ministry of Health. The aim of these surveys was to evaluate antidotes availability in the Emergency Services (PCCs, EDs, intensive care units) and Hospital Pharmacies of the National Health System (NHS) throughout the Italian country. As a result of this initiative, since 2006, the collected data were organized in a specific “National data-base of antidotes” (BAnDA), available online (
Regarding Spain, in July 2015, the Xarxa d’Antídots de Catalunya was created to interconnect public and private hospitals throughout the community. It includes the provision, in these centers, of 18 antidotes for which there may be problems of availability due to the aforementioned factors.
The experience of the first few years has been very positive, both in terms of the number of hospitals adhered to and the toxicological consultations received, and loans made. For this reason, and with the intention of extending this project throughout the country, the Antidote Network was created. The Balearic Islands has been the first community to join and it is planned to expand with more regions in the near future.
To describe and to make a revision of Antidotes and their importance as an essential drug for management of acute intoxications.
To give several evidences that the availability problems about stocking of antidotes in hospitals are an important concern, due to the lack of a National Regulation.
To show the importance and responsibility that Pharmacy Departments are for warranting an optimal qualitative and quantitative stock of these drugs.
In this context, the main objective is to propose a detailed review of the Antidotes Network that has been created in the Spanish territory.
Within the framework of the Catalan Society of Clinical Pharmacy, a working group formed by pharmacists and doctors with experience in the field of Clinical Toxicology was created to develop the network. First, the group prepared a document with recommendations on the storage of antidotes according to the complexity and location of the hospital. An online application was then intended to be utilized as a specialized instrument between centers.
The application collects information on 15 antidotes, selected according to criteria of availability, urgency, frequency of use or cost (fragments of digoxin antibodies, methylene blue, deferoxamine, dimercaprol, calcium sodium edate, ethanol, physostigmine, fomepizole, glucagon, hydroxocobalamin, pyridoxine, pralidoxime, silibinin, botulinum antitoxin and snake venom antiserum). This tool provides information on the stock of each center (including the expiration date) and facilitates the loan of antidotes between hospitals.
The online application “Red de Antidotos” was propelled in July 2015. It has an open region with data about the task and offers the probability of non-dire toxicological discussions to the specialists of the gathering, and a private zone available with username and secret key for the focuses that have joined the network. So far 34 Catalan clinics offering crisis care have been fused. In each inside there is a drug specialist and a specialist from the Emergency Department in charge of the network. These figures are designated “farmatox” and “urgetox”. The “farmatox” is responsible for the support of the stocks, refreshes the developments of medications and arranges and loan antidotes between emergency clinics. The “urgetox” builds up the elements of toxicology referent of the Emergency Department.
The network of antidotes is a really intuitive and helpful device. The private region is separated into four segments. The Antidote segment contains data on antidotes, which can be counseled on the web. It is a powerful list, kept up by the individuals from the gathering, which gathers information on toxicological signs, measurements with the best agreement for the two grown-ups and kids, accessible definitions, perceptions on organization, strength, unfriendly responses and different contemplations to be considered, just as the prescribed amounts to be put away relying upon the multifaceted nature of every medical clinic.
The Antidote Stock Management segment gathers the accessible measure of antitoxins in the network put away in every emergency clinic. The application permits the “farmatox” to enter any section and leave development. Every passage must include: medicine, number of units, bunch, lapse date and sort of development. For the last mentioned, two sorts of passage developments have been characterized (buy of drugs and return of the advance to another medical clinic), and three kinds of leave developments (claim use, termination and credit).
All developments for stock refreshing (credit developments just as for possess use) must be done physically by the drug specialist mindful in every emergency clinic. To encourage this stock upkeep, the application enables you to print a record with the units entered for each clump and the lapse date for each group. Lapsed units are featured in red.
The application enables you to scan for antidotes by drug or by medical clinic, in the area of the guide that demonstrates the data of the considerable number of emergency clinics incorporated into the network. At the point when the inquiry is done by clinic, the accompanying information can be counseled on the guide: name of the “farmatox” and the “urgetox”, address, phone, email, fax and opening times of the Pharmacy, Department and phone of the Emergency Unit. It likewise demonstrates every one of the antidotes accessible in the inside, with their number of units and the following expiry date. At the point when the antitoxin search is played out, all clinics in which the cure is accessible will be shown, just as the quantity of accessible units and the following termination date.
The network was first implemented in Catalonia and now the project is being extended to other Spanish regions (currently it has been implemented in three out of 17 regions, Figure 1), with the aim to continue improving communication between professionals involved in intoxication management, sharing knowledge and improving the care we offer to our patients.
Centers of the Antidotes Network in Spain.
There are presently 63 Spanish emergency clinics incorporated into the Antidotes Network. It has been utilized multiple times to find a remedy that was vital and to apply for an advance between focuses. Up until this point, 13 counteractants have been engaged with these developments. The most requested drugs are represented in the image below (Figure 2). Likewise, proposals on stock accessibility and utilization of antidotes as indicated by the multifaceted nature of the medical clinic were distributed and are accessible in the Emergencias Journal.
Most request drugs. Source: Aguilar-Salmerón et al [7].
As a result of this project, “the Antidotes Guide” was published, that includes recommendations for the availability of 38 antidotes depending on the level of complexity of the hospitals and information on toxicological indications, posology and other observations of interest.
In the private part of the Antidotes Network, the stocks of the adhered hospitals are available for those antidotes in which availability problems may occur. Currently there are 18 antidotes included in the private part of the Network (Table 1).
Antidotes | Commercial presentations | Initial dosing |
---|---|---|
Antidigoxin antibodies | Digifab® 40 mg vial Refrigerator. Foreigner | IV 40 mg per 0.5 mg digoxin. If unknown digoxin quantity 400 mg (10 vials). To reconstitute with 4 mL of water + 250 mL PS 30 minutes inf. It may be necessary to repeat doses |
Dantrolene | Dantrolen® 20 mg vial | IV 2.5 mg/kg (each vial in 3 min) preferably via central. Maximum doses reached 10 mg/kg |
Deferoxamine | Desferin® vial 500 mg | IM 2 g in 10 mL Water or IV 15 mg/Kg/h (max. 80 mg/Kg/24 h) |
Defibrotide | Defibrotide® 200 mg/2.5 mL vial | IV 6.25 mg/kg/h in 2 h |
Dimercaprol (bal, British anti-lewisite) | Dimercaprol® amp. 200 mg c/12 amp 2 mL. Foreigner | IM 3 mg/Kg/4 h for 2 days |
Calcium edetate sodium (EDTA) | Calcium Edetate sodium® amp.500 mg/10 mL c/10 amp. Foreigner | IV 1000 mg in 250 mL SF 6 hours infusion. Repeat every 12 h for 5 days |
Ethanol (absolute ethanol) | Absolute ethanol® amp 10 mL Pharmaceutical Compounding | IV. 1 mL/Kg in D 5% 50 mL in 1 h. Continue with 0.1 mL/Kg/h. If alcoholic, double dose. Requires analytical control e/6h |
Physostigmine | Anticholium® 2 mg/5 mL amp | IV 1–2 mg in 2 min. Repeat each bolus every 10–30 min. Alternatively: 2 mg/h up to a maximum of 8 mg/h |
Fomepizole | Fomepizol® vial 100 mg | IV Loading dose of 15 mg/kg in 100–250 mg of NaCl 0.9% or D 5% and administered in 30–45 min |
Glucagon | Glucagon Gen Hypokit® 1 mg syringe | IV 5 mg in 1 min. Repeat, if needed, in 10 min |
Glucarpidase | Voraxazane® 1000 U vial | IV 50 U/kg in 5 min injection |
Hydroxocobalamin | Cyanokit® 5 g vial | IV 5 g in 10 min (2.5 g if <35 Kg). If cardiac arrest 10 g in 10 min. If after 1 h there is no change, 5 more grams in 15 min |
Idarucizumab | Praxbind® 2.5 g injectable solution | IV 5 g (2 vials) in two consecutive infusions or in one infusion |
Pralidoxime (pam) | Contrathion® vial 200 mg/10 mL c/10 vials-amp. Foreigner | IV 1 g in 100 mL G 5 % 1 h infusion. If necessary, continue with the same dose every 6 h for 2–3 days. |
Silibinin | Legalon® vial 350 mg | IV 5 mg/kg in 500 mL NaCl 0.9% or D 5% in 2 h. Repeat each 6 h (3–4 days) |
Antibotulinum serum | Botulism Antitoxin Heptavalent A, B, C, D, E, F, G (BAT) 50 mL injectable solution | IV dilute 1 vial 1:10 and administer at 0.5 mL/min during 30 min. Maximum rate of 2 mL/min |
Antiophidic serum | Snake venom antiserum (Bulbio®) vial 100 UI (5 mL). Foreigner | One dose corresponds to 100 IU (1 vial). First dose given via SC at the site of the sting, second dose via IM in the buttock. Further doses may be necessary at a later time as clinically determined. |
Uridine triacetate | Vistonuridine® 10 g sachet | PO 10 g each 6 h, 20 doses |
Antidotes included in the private part of the Network.
Note also that the list of antidotes included in the network will change according to the needs of its hospitals, any epidemiological changes in poisoning, the launch of new antidotes, and problems for supply of others.
The consultations section is a tool very useful that the Antidote Network offers to any Health Professional the possibility of carrying out various types of toxicological consultations, as: (i) intoxications in which an antidote could be used, (ii) antidotes that could be used in some types of poisonings, (iii) agents used for digestive, cutaneous or ocular decontamination (iv) recommendations on qualitative and quantitative availability of antidotes.
Also, this section offers the possibility that the answer to some of these questions can be found by the reader in the Antidote Guide that can be found in this website.
For urgent medical consultations due to poisonings and toxicological emergencies, it is possible to contact by telephone the Toxicological Information Service of the National Institute of Toxicology and Forensic Sciences as this Service offers toxicological advice 24 h a day, 365 days a year. Otherwise, for non-urgent consultations on Clinical Toxicology, pharmacological aspects of antidotes or on drugs that can cause intoxications, it is possible to contact the experts of the Group of antidotes, specialized in assistance to acute intoxications in both adults and pediatrics, via an official email published on the official website.
It is necessary to guarantee an adequate stock of antidotes in those hospitals managing poisoned patients; however, this is not always simple to realize.
Making a database of refreshed supplies of antitoxins open to all medical clinics overseeing clinic crises is definitely not another thought. New Zealand emergency clinics have just recommended its creation as an answer for the inadequacies found [7, 8]. Similarly, the “Centro Antiveleni di Pavia - Centro Nazionale di Informazione Tossicologica” made the Banca Dati Nazionale degli Antidoti (BaNdA), in light of an investigation of the accessibility of antidotes in Italian Emergency Units, among others [9, 10, 11, 12, 13, 14, 15, 16]. It is an on-line stage that permits to discover refreshed information on the subjective and quantitative accessibility of counteractants in all the clinic units required, to look for a particular antitoxin by city or area and to get to all the contact information important to apply for an advance.
Some information on antitoxins and how they are arranged through Spanish antidote network as antitoxins are always a problem for both developing and developed countries. Particularly, some information on botulinum antitoxins and anti-venoms:
Botulism Antitoxin Heptavalent—A, B, C, D, E, F, G (BAT), solution for injection: Adult dosage administration: Dilute the vial in a ratio of 1:10 and administer at a speed of 0.5 mL/min for 30 min and increase to double the speed every 30 min up to a maximum of 2 mL/min. For child dosage: Between 20 and 100% of the vial according to body weight. In children under 1 year the dose is 10% of the vial regardless of body weight. For administration: Dilute the vial in a ratio of 1:10 and administer at a speed of 0.01 mL/kg/min and increase by 0.01 mL/kg/min every 30 min to a maximum of 0.03 mL/min without exceeding adult rates. For dilution: Since the filling volume of each vial varies depending on the lot number (approximately 10–22 mL per vial), 90–200 mL of saline solution will be required for dilution. Conservation conditions: Store frozen or below ≤−15°C until used. Once thawed, it can be stored at 2–8°C for up to 36 months or up to 48 months from the date of manufacture (whichever comes first). Do not refreeze the vial. Administer the drug at room temperature. To defrost it, leave it at room temperature for 1 h and then immerse it in a bath of water at 37°C until it defrosts completely.
Snake Venom Antiserum (Bulvio® and Viperfav®): Adult and child dosage:
Viperfav: IV Perfusion of 4 mL of serum (1 vial) in 100 mL SF at 50 ml/h.
Snake Venom Antiserum: 100 IU (5 mL) via SC, followed by a second IM dose in the buttock. 1,2 or more IM doses may be necessary depending on the patient’s condition and on the second and third days 1 or 2 more doses may be needed. Viperfav® has a low risk of anaphylactic reactions. On the other hand, in the case of Snake Venom Antiserum® it is recommended to carry out a hypersensitivity test prior to its administration.
Building up a network of antitoxins can improve correspondence between focuses that oversee harmed patients, adjust and institutionalize antidotes assets in various focuses, and accelerate credits if essential. Eventually, it can improve the nature of consideration for harmed patients.
Antidote Network could allow improved communication between centers involved in the management of poisoned patients, help in adjusting and harmonizing antidotes stock and accelerate antidote borrowing, if required.
Furthermore, this Antidote Network provide prompt and easy access to antidotes (especially expensive and rare-use ones), to rapidly find them in the nearby hospitals or regions (avoiding lengthy and expensive transport), and it is useful also to optimize antidote stockpiles with saving of resources.
As future proposals it would be very convenient to expand the network throughout the national territory and implement it in other countries, which would allow an increase in the quality of life of the patient and an improvement in public health.
The author declares no conflict of interest.
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He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). 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His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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